October 2, 2009

Researchers at Rush University Medical Center have found that a program of pelvic floor muscle exercises, combined with pelvic health education, can be an effective way to manage urinary incontinence in elderly women.

The study, involving 65 women between the ages of 67 and 95, is being presented this week at the annual meeting of the North American Menopause Society in San Diego.

Urinary incontinence, or loss of bladder control, is a frustrating, and often embarrassing, problem for more than 13 million Americans. It is twice as common in women as in men, and, according to some estimates, affects half of older women. In women, the muscles that help support the bladder may become weak due to multiple pregnancies and vaginal births.

"Urinary incontinence can take a very real emotional and social toll. Not knowing when and where you might have an accident can impact everything from household chores to dinner dates and bowling games," said physiatrist Dr. Sheila Dugan, co-director of the Program for Abdominal and Pelvic Health at Rush and lead author of the study.

"Many treatment options exist, but strengthening the pelvic floor muscles, as our study has shown, can be very effective even for older women, avoiding the need for drugs or more invasive procedures."

The women in the study's treatment group underwent a supervised chair-based exercise program for six weeks. The program focused on identifying, isolating and strengthening muscles that support the pelvic area: the transversus abdominus, the corset-like swath of muscles that wraps around the abdomen; the multifidus, which extends along the back of the trunk; and the pelvic floor muscles, which form a sling to hold up internal organs like the bladder. In addition to the exercises, the program incorporated an educational curriculum (four sessions) on basic bladder and pelvic health. The control group received one session of educational basics and no supervised training in pelvic exercises.

At the end of the program, 83 percent of the women in the treatment group reported that their symptoms had improved. On the whole for the control group, there were no statistically significant improvements.

The researchers found statistically significant improvements in the treatment group in a number of areas. Problems with frequency of urination, urine leakage related to feelings of urgency and urine leakage caused by physical activity, coughing or sneezing had all decreased. Bladder control problems were less bothersome and also had less of an impact on daily activities like household chores.

The women in the treatment groups also reported less urgency during night-time hours, better bladder management (especially when physically active or sneezing) and increased self-confidence. Eighty-two percent reported that they planned on continuing the exercise themselves after the intervention.